Provider Demographics
NPI:1710283304
Name:PISARCIK, KIMBERLY ANN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN MARIE
Last Name:PISARCIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TARLETON AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1248
Mailing Address - Country:US
Mailing Address - Phone:570-310-1214
Mailing Address - Fax:570-310-1273
Practice Address - Street 1:1 TARLETON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1248
Practice Address - Country:US
Practice Address - Phone:570-310-1214
Practice Address - Fax:570-310-1214
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0168841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025703090004Medicaid